20181215运医读书笔记

BACKGROUND:: The surgical treatment of recurrent shoulder instability has evolved in recent years to include a variety of soft tissue and bone block procedures, undertaken with either an open or arthroscopic approach. Although the utilization of such techniques has rapidly expanded, the associated risk of complications remains poorly defined. This information is vital for clinical decision making and patient counseling.

研究背景：肩关节不稳的外科术式，包括开放或镜下，包括软组织修复或骨性修复。手术方式的发展带来的并发症却不能完全明了。对上述进一步明确有利于医生的临床决策和患者宣教。

PURPOSE:: To quantify the complication rate associated with all types of surgery for anterior glenohumeral joint dislocation.

研究目的：量化肩关节前脱位相关术式的并发症。

STUDY DESIGN:: Systematic review.

METHODS:: A systematic search was undertaken of studies reporting complications from anterior shoulder stabilization surgery. Inclusion criteria were studies published in English between 2000 and 2017 with a minimum 2-year follow-up. Methodological quality of the included studies was assessed with the Methodological Index for Non-Randomized Studies criteria. Complication rates for all undesirable events contributing to the patient outcome were extracted and cumulative rates calculated.

对肩关节前方修复手术并发症进行系统性搜索，纳入标准：英文发表，2000-2017年，至少2年随访；方法量化参照方法指数的非随机研究标准。统计患者不良事件的并发症比例。

RESULTS:: Out of 1942 references, 56 studies were included, totaling 4362 procedures among 4336 patients. Arthroscopic soft tissue repair had a complication rate of 1.6% (n = 2805). When repair was combined with arthroscopic remplissage, the rate was 0.5% (n = 219). Open soft tissue repair had a complication rate of 6.2% (n = 219) and open labral repair with remplissage, a rate of 2.3% (n = 79). An open bone block procedure had a complication rate of 7.2% (n = 573) and an arthroscopic bone block procedure, a rate of 13.6% (n = 163).

关节镜软组织修复并发症1.6%。同期做软组织填塞技术的并发症是0.5。开放软组织修复的并发症是6。开放软组织修复加后方填塞的技术是2。开放骨性技术是7。镜下骨性技术是13。

CONCLUSION:: This large systematic review demonstrates the overall complication rates (not purely recurrence rates) in modern shoulder stabilization surgery. With the growing interest in bone block stabilization procedures, including those performed arthroscopically, surgeons should be aware of the 10-fold increase in complications for these procedures over soft tissue arthroscopic surgery and counsel their patients accordingly.

结论，所有会出现的并发症，不单纯是再脱位几率，关节镜下骨性阻挡技术的并发症是关节镜下软组织修复技术的10倍。

非常有意思的结论。对于此我有一些自己的想法。

Latajet技术难度要远远高于Bankart技术，手术过程中非常可能有神经等方面的损伤，从手术过程中就可以明确。而且学习曲线长。所以得出上述的结论是比较正常的。这篇文章的问题，是没有把主刀医生的经验值水平作为考量，个人觉得会导致明显的资料偏移。